-Automatic translation

Article 2 of the Act on Death Certificates, Autopsies, etc., No. 1998/61, states that “a doctor shall examine the body and investigate the circumstances of death, the signs of death, and the probable cause of death.” The doctor in question is thus legally entrusted with correctly registering the cause of death.

Subsequently, it was decided to consult independent experts to review the registration of these deaths because this was the first time in the country's recorded history that a vaccination was registered as a cause of death, and also because the deaths occurred over a relatively brief period.

The Directorate of Health sought the help of independent experts to evaluate the death certificates. They were Anna Björg Jónsdóttir, a specialist in geriatric medicine and Chief Physician of Geriatric Medicine at Landspítali, and Ólafur Þór Gunnarsson, a specialist in internal and geriatric medicine and Chief Physician of the geriatric medicine rehabilitation department at Landspítali. Both have decades of experience in providing geriatric services in hospitals and nursing homes.

After reaching this conclusion, representatives from the Directorate of Health met with the doctor who issued the certificates in question. The report was then presented and discussed. Subsequently, the doctor reviewed the death certificates and updated them regarding the cause of death without the Directorate's involvement.

It should be noted that the Directorate of Health often communicates with doctors regarding the registration of causes of death, and this communication has, without exception, gone smoothly. The same applies to the communication with the issuing doctor in this case. All diagnoses recorded on a death certificate are coded according to ICD-10 and WHO rules for registering causes of death. Sometimes, missing information on a certificate prevents proper coding, or the cause of death is deemed insufficient under registration rules. In such cases, the Directorate collaborates with the doctor involved to ensure the registration is completed.

The conclusion of the independent experts also notes that there is reason to consider whether there was justification for vaccinating the individuals in question at that time, as some were acutely ill and all were frail or very frail. It emphasises that an individualised assessment should be made regarding whether vaccination is suitable for nursing home residents, taking into account their health on the one hand, and, on the other, following the recommendations of the Chief Epidemiologist and the Directorate of Health concerning the vaccination of older and frailer individuals.

In this context, the Directorate emphasises that vaccination should generally be deferred for individuals with acute illness, fever, or an infection, and reassessed once the person's condition has improved. This applies to all age groups, but especially to the elderly. For older and frail individuals, it is necessary to evaluate on a case-by-case basis whether to proceed with vaccination, particularly for those considered to be near the end of life. If an individual's condition is deteriorating, a personalised assessment must be made to determine whether it is appropriate to postpone or cancel the vaccination. In light of the recommendations from the independent experts, the Chief Epidemiologist plans to reiterate these guidelines to nursing homes.

More information
Kjartan Hreinn Njálsson, Assistant to the Medical Director of Health
kjartan.h.njalsson@landlaeknir.is